Doyle McManus: Time to reform Medicare

It’s hard to recognize the Democratic
Party these days. In recent decades, it’s been a divided, brawling tribe. But
this year, Democrats are one big, happy family.

Sure, there was grumbling from the left
over President Obama’s agreement to keep tax cuts in place for couples making
between $250,000 and $450,000 a year. But that quickly gave way to satisfaction
that Obama had won the “fiscal cliff” fight.

Two factors have given Democrats this
unusual sense of unity and well-being: the surprisingly big margin by which
Obama won November’s presidential election, and the obduracy of House
Republicans in refusing to notice that their arguments lost.

If the GOP wants to keep alienating
voters by telling them they’re wrong, the Democrats are happy to offer them
more opportunities.

In recent weeks, the president has made
it clear that he will push for significant immigration reform and gun control
measures, issues on which Democrats believe the GOP is out of step with
mainstream opinion.

“The dominant sense among Democrats is
that the party is on a roll,” said William A. Galston, a former Bill Clinton
aide now at the Brookings Institution. “And why not? 2012 was a victory, after
all.”

But there’s a cloud on the Democrats’
blue horizon: the unsolved problems of federal spending and the national debt.

As Obama has acknowledged, if federal
spending continues to grow unabated — especially on the big entitlement
programs of Medicare, Medicaid and Social Security — there won’t be enough
money in the Treasury to pay for much else. The modest increases in tax revenue
he just obtained won’t be significant over the long run.

There’s no escape from the spending
problem. By the end of February, Congress must either undo the automatic
sequester of federal funding that it ordained in earlier bouts of budget
wrestling or see savage cuts to domestic and defense programs.

That’s when the Republicans’ best chance
to press for spending cuts will come. And that’s when Democrats could revert to
their traditional feuding ways — because, as even Obama agrees, the biggest
target for reductions is one of the Democrats’ favorite programs: Medicare.

“I agree with Democrats and Republicans
that the aging population and the rising cost of health care [make] Medicare
the biggest contributor to our deficit,” Obama said during the fiscal cliff
negotiations. “I believe we’ve got to find ways to reform that program without
hurting seniors who count on it to survive.”

Medicare already accounts for about 15
percent of federal spending, and the Congressional Budget Office projects that
the cost will nearly double in 10 years if no changes are made. Bringing
federal spending under control without touching Medicare simply isn’t
practical.

But it’s a prospect that chills many
Democrats because defending Medicare and Social Security benefits is the
clearest unifying doctrine their party has, just as resisting tax increases is
for Republicans.

So though Obama may agree in theory
about the need for cuts, deciding what to cut is certain to be divisive. On the
party’s left, many progressives hate the idea of touching Medicare at all. In
2011, after Obama flirted with accepting an increase in the Medicare
eligibility age from 65 to 67 in talks with House Speaker John A. Boehner,
R-Ohio, labor unions and other progressive groups quickly organized campaigns
to denounce the idea.

In the party’s center, pro-business New
Democrats worry that without major changes in Medicare, the federal deficit
will balloon and the economy will suffer. But they didn’t hear much
encouragement from Obama this week.

At his news conference Monday, instead
of calling for far-reaching reforms, Obama said merely, “I’m open to making
modest adjustments to programs like Medicare.”

And instead of proposing steps toward
bipartisan consensus on the issue — the only way to fix Medicare because
without it any changes will simply become fodder for election campaign attacks
by both sides — Obama took a brass-knuckled swipe at GOP conservatives.

“They are suspicious about government’s
commitments … to make sure that seniors have decent health care,” the president
said. “They have suspicions about Social Security.”

Attacks like that may be great for party
unity in the short run. But they’re a distraction from what Obama and his
allies should be doing: building support among their own voters for real reform
in Medicare, and then working to bring pragmatic Republicans along.

Otherwise, the now-victorious Democrats
risk finding themselves, four years from now, in much the same place
Republicans are today: so absorbed in maintaining their own unity that they’ve
lost voters’ confidence in their ability to govern.

DOYLE
MCMANUS is a columnist for the Los Angeles Times. His column is distributed by
MCT Information Services.

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